The present invention relates in general to the performance of a variety of surgical steps or procedures during surgical operations and, more particularly, to methods and apparatus for utilizing ultrasonic sensing as an integral part of such surgical procedures to expedite and facilitate their performance and to extend a surgeon's sense of "feel". While the methods and apparatus of the present invention are generally applicable to the performance of these surgical procedures during any operation, they are particularly applicable to their performance during endoscopic surgery and, accordingly, will be described herein with reference to this application.
The scope of surgical operations which can be performed using endoscopic surgery is constantly being expanded. Endoscopic surgery is often preferred due to its limited invasive nature and the corresponding reduced recovery time. For example, in an endoscopic procedure performed within the abdomen, rather than making a relatively large abdominal wall opening for surgical access, small cannulas are inserted through the abdominal wall with endoscopic instruments being inserted through the cannulas and manipulated by a surgeon to perform the endoscopic surgery.
Two operations which commonly can be performed to advantage using endoscopic surgical techniques are gall bladder surgery and surgical repair of an abdominal hernia. In both instances, one cannula permits introduction of a combination illuminating and viewing instrument and a second cannula permits introduction of a number of different endoscopic surgical instruments which are used for performing surgical steps or procedures required to complete the surgical operation prior to removing the cannulas and closing the relatively small openings required for their insertion.
A problem in using certain surgical instruments that is particularly apparent during endoscopic surgery is the lack of the surgeon's sense of feel. In non-endoscopic surgery, a surgeon can normally easily verify the identification of structures within a conventional surgical opening. In particular in the two noted operations, the surgeon normally uses the sense of feel to verify the nature of visually identified vessels.
In a gall bladder operation, for example, the bile duct must be distinguished from a blood vessel which passes close to the duct. The locations of blood vessels must be determined in the repair of an abdominal hernia using endoscopic surgery since such repair is performed by stapling a section of polymeric mesh material to the inside of the abdominal wall. The material securing staples must be placed to ensure that a blood vessel is not stapled during the repair.
The identification of blood vessels during endoscopic surgical operations has been addressed in the prior art. For example, in U.S. Pat. No. 4,770,185 issued to Silverstein et al, an ultrasonic probe is disclosed wherein pulsed ultrasonic energy is used in a catheter to identify both venous and arterial blood flow. A resulting Doppler signal is used to drive a loudspeaker such that the sense of hearing is used in place of the surgeon's sense of feel.
In one of the embodiments disclosed in Silverstein et al, vessels are identified prior to use of a separate instrument, such as a papillotome catheter. For this embodiment, the ultrasonic probe must first be inserted through a cannula, utilized for identification of vessels, and withdrawn from the cannula to permit insertion of the papillotome catheter.
Silverstein et al's ultrasonic probe is also disclosed as being incorporated into the end of a papillotome catheter, such that blood vessels can be sensed as the catheter is advanced toward an operating position, and into the end of a catheter through which a needle may be deployed. The scanning direction of the ultrasonic probes is disclosed as being selectable to be highly directional, sectorially directed or omnidirectional. However, in the disclosed combination ultrasonic probe/catheter embodiments, while the ultrasonic scanning and surgical procedures can be performed without removal and replacement of catheters, the scanning is not directed to the operational region of the associated catheters.
Accordingly, there is a need for improved ultrasonically assisted surgical procedures which can be utilized in a growing number of surgical instruments, including and with particular benefit for endoscopic surgical instruments, wherein the ultrasonic monitoring is performed within an operational field of the surgical instrument. Such improved ultrasonically assisted surgical procedures would permit monitoring within the operational field prior to, during and after a surgical procedure to help ensure successful performance and completion of the procedure. While the results of the ultrasonic sensing can be audibly produced, preferably the improved ultrasonically assisted surgical procedures would extend and restore the surgeon's sense of feel for performance of surgical procedures.